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Genitourinary Cancer

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

Urology Department, Inselspital, Bern, Switzerland

Key Words. Extended pelvic lymph node dissection • Bladder cancer • Prostate cancer

Correspondence: Fiona Burkhard, M.D., Urology Department, Anna Seiler Haus, Inselspital, 3010 Bern, Switzerland. Telephone: 0041-316322111; Fax: 0041-316322180; e-mail: fiona.burkhard{at}insel.ch

Received May 27, 2008; accepted for publication December 7, 2008; first published online in THE ONCOLOGIST Express on January 14, 2009.

Disclosures

Ramesh Thurairaja: None; Urs E. Studer: None; Fiona C. Burkhard: Consultant/advisory role: Medtronic

Section editors Chris Parker and Matthew R. Smith have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer.

The role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.